Comparison of central corneal thickness measured by automatic and manual analysis of optical coherence tomography.

PURPOSE: To compare central corneal thickness (CCT) measured with optical coherence tomography (OCT) using an automatic algorithm (A-OCT) vs. manual measurements (M-OCT) with respect to the gold standard ultrasound pachymetry (USP). METHODS: CCT measurements were performed on both eyes of 28 healthy subjects at four times of the day. A-OCT used an automatic software analysis of the corneal image, M-OCT was performed by two operators by setting a digital calliper on the corneal borders, and USP was performed after corneal anesthesia. Measurements were compared using a three-way repeated measures ANOVA. Bland-Altman plots were used to evaluate the agreement between OCT measurements and USP. RESULTS: Both A-OCT and M-OCT significantly underestimated the USP measures, with the mean difference, i.e., the systematic error, being larger for A-OCT (- 19.0 µm) than for M-OCT (- 6.5 µm). Good reproducibility between the two operators was observed. Bland-Altman plots showed that both OCT methods suffered from proportional errors, which were not affected by time and eye. CONCLUSIONS: Measuring CCT with OCT yielded lower values than USP. Therefore, clinicians should be aware that corneal thickness values may be influenced by the measurement method and that the various devices should not be used interchangeably in following up a given patient. Intriguingly, M-OCT had less systematic error than A-OCT, an important outcome that clinicians should consider when deciding to use an OCT device.

Structural and connectivity parameters reveal spared connectivity in young patients with non-progressive compared to slow-progressive cerebellar ataxia.

Introduction: Within Pediatric Cerebellar Ataxias (PCAs), patients with non-progressive ataxia (NonP) surprisingly show postural motor behavior comparable to that of healthy controls, differently to slow-progressive ataxia patients (SlowP). This difference may depend on the building of compensatory strategies of the intact areas in NonP brain network. Methods: Eleven PCAs patients were recruited: five with NonP and six with SlowP. We assessed volumetric and axonal bundles alterations with a multimodal approach to investigate whether eventual spared connectivity between basal ganglia and cerebellum explains the different postural motor behavior of NonP and SlowP patients. Results: Cerebellar lobules were smaller in SlowP patients. NonP patients showed a lower number of streamlines in the cerebello-thalamo-cortical tracts but a generalized higher integrity of white matter tracts connecting the cortex and the basal ganglia with the cerebellum. Discussion: This work reveals that the axonal bundles connecting the cerebellum with basal ganglia and cortex demonstrate a higher integrity in NonP patients. This evidence highlights the importance of the cerebellum-basal ganglia connectivity to explain the different postural motor behavior of NonP and SlowP patients and support the possible compensatory role of basal ganglia in patients with stable cerebellar malformation.

Brain Noradrenergic Innervation Supports the Development of Parkinson's Tremor: A Study in a Reserpinized Rat Model.

The pathophysiology of tremor in Parkinson's disease (PD) is evolving towards a complex alteration to monoaminergic innervation, and increasing evidence suggests a key role of the locus coeruleus noradrenergic system (LC-NA). However, the difficulties in imaging LC-NA in patients challenge its direct investigation. To this end, we studied the development of tremor in a reserpinized rat model of PD, with or without a selective lesioning of LC-NA innervation with the neurotoxin DSP-4. Eight male rats (Sprague Dawley) received DSP-4 (50 mg/kg) two weeks prior to reserpine injection (10 mg/kg) (DR-group), while seven male animals received only reserpine treatment (R-group). Tremor, rigidity, hypokinesia, postural flexion and postural immobility were scored before and after 20, 40, 60, 80, 120 and 180 min of reserpine injection. Tremor was assessed visually and with accelerometers. The injection of DSP-4 induced a severe reduction in LC-NA terminal axons (DR-group: 0.024 ± 0.01 vs. R-group: 0.27 ± 0.04 axons/um2, p < 0.001) and was associated with significantly less tremor, as compared to the R-group (peak tremor score, DR-group: 0.5 ± 0.8 vs. R-group: 1.6 ± 0.5; p < 0.01). Kinematic measurement confirmed the clinical data (tremor consistency (% of tremor during 180 s recording), DR-group: 37.9 ± 35.8 vs. R-group: 69.3 ± 29.6; p < 0.05). Akinetic-rigid symptoms did not differ between the DR- and R-groups. Our results provide preliminary causal evidence for a critical role of LC-NA innervation in the development of PD tremor and foster the development of targeted therapies for PD patients.

Pediatric Slow-Progressive, but Not Non-Progressive Cerebellar Ataxia Delays Intra-Limb Anticipatory Postural Adjustments in the Upper Arm.

We recently investigated the role of the cerebellum during development, reporting that children with genetic slow-progressive ataxia (SlowP) show worse postural control during quiet stance and gait initiation compared to healthy children (H). Instead, children with genetic non-progressive ataxia (NonP) recalled the behavior of H. This may derive from compensatory networks, which are hindered by disease progression in SlowP while free to develop in NonP. In the aim of extending our findings to intra-limb postural control, we recorded, in 10 NonP, 10 SlowP and 10 H young patients, Anticipatory Postural Adjustments (APAs) in the proximal muscles of the upper-limb and preceding brisk index finger flexions. No significant differences in APA timing occurred between NonP and H, while APAs in SlowP were delayed. Indeed, the excitatory APA in Triceps Brachii was always present but significantly delayed with respect to both H and NonP. Moreover, the inhibitory APAs in the Biceps Brachii and Anterior Deltoid, which are normally followed by a late excitation, could not be detected in most SlowP children, as if inhibition was delayed to the extent where there was overlap with a late excitation. In conclusion, disease progression seems to be detrimental for intra-limb posture, supporting the idea that inter- and intra-limb postures seemingly share the same control mechanism.

A single session of whole-body cryotherapy boosts maximal cycling performance and enhances vagal drive at rest.

Whole-body cryotherapy (WBC) has been reported to maximize physical recovery after exercise and reduce the ensuing muscle damage. In addition, WBC triggers cardiovascular responses leading to an increased vagal drive. Here we tested whether WBC may boost exercise performance as well as post-exercise recovery. Moreover, we compared the effects of WBC and exercise on sympathovagal balance and tested whether these two factors may interact. ECG was recorded in 28 healthy adults who underwent rest, all-out effort on a cycloergometer, 5 min recovery and again rest. After 3-5 days, WBC (3 min exposure to - 150 °C air) was applied and the whole procedure repeated. Total exercise duration was split into the time needed to reach peak power output (tPEAK) and the time to exhaustion (tEXH). The post-exercise exponential decay of HR was characterized by its delay from exercise cessation (tDELAY) and by its time constant (τOFF). Sympathovagal balance was evaluated by measuring HR variability power in the low (LF) and high (HF) frequency bands, both before exercise and after recovery from it. Sympathetic vs. vagal predominance was assessed by the sympathovagal index LFnu. Paired t-tests indicated that WBC increased tEXH and reduced tDELAY, speeding up the HR recovery. These results suggest that WBC may be exploited to boost exercise performance by about 12-14%. ANOVA on HR variability confirmed that exercise shifted the sympathovagal balance towards sympathetic predominance, but it also highlighted that WBC enhanced vagal drive at rest, both before exercise and after full recovery, covering ~ 70% of the exercise effect.

Attentive Processes and Blood Lactate in the Sambo.

BACKGROUND: Sambo is a martial art and combat sport that originated in the Soviet Union. There are two main stiles, Sport Sambo and Combat Sambo which resembles modern mixed martial arts. Very little literature is available about physiological aspects of Sambo and, in particular, on the possible effects on cognitive domains. The purpose of the present research was to determine if there is a correlation between a blood lactate increase and the intensity and/or selectivity of attentions. METHODS: Sixteen male athletes practicing Sambo for at least 5 years participated voluntarily in the study. Each athlete had to sustain, with an interval of one week, both a Sport Sambo match and a Combat Sambo match, each lasting 5 min. Blood lactate levels as well as attentive capacities were evaluated at three different times: at rest, i.e., 5 min before the start of the session (pre), at end of the session and 15 min after its conclusion. Reaction time protocol was used to evaluate the intensity of attention, whereas divided attention was assessed for analyzing the selectivity of attention together with errors and omissions. RESULTS: Concerning Sport Sambo, blood lactate was 1.66 mmol/L (±0.55 SD) before the session, reached a mean value of 3.40 mmol/L (±0.45 SD) at the end of the session (end) and returned to values similar to initial ones (a mean value of 1.98 mmol/L (±0.37 SD) after 15 min (15-end). None of the attentive parameters examined, showed statistically significant differences. Conversely, for Combat Sambo, it was found a significant increase in blood lactate levels that went from 1.66 mmol/L (±0.55 SD) before the session (pre), to 4.76 mmol/L (±0.60 SD) at the end (end) and then back to values similar to those observed before the session 15 min after its conclusion (15-end), i.e., 1.97 mmol/L (±0.37 SD); however, after a Combat Sambo session increases in blood lactate were associated with significant worsening of attentional mechanisms. CONCLUSIONS: In conclusion, in all the participants, the worsening of attentional mechanisms was observed only after the Combat Sambo session in which blood lactate values exceeded 4 mmol/L. This figure, also known as the Onset of Blood Lactate Accumulation (OBLA), is commonly used to determine the anaerobic threshold.

A Novel Viewpoint on the Anticipatory Postural Adjustments During Gait Initiation.

Anticipatory postural adjustments (APAs) are the coordinated muscular activities that precede the voluntary movements to counteract the associated postural perturbations. Many studies about gait initiation call APAs those activities that precede the heel-off of the leading foot, thus taking heel-off as the onset of voluntary movement. In particular, leg muscles drive the center of pressure (CoP) both laterally, to shift the body weight over the trailing foot and backward, to create a disequilibrium torque pushing forward the center of mass (CoM). However, since subjects want to propel their body rather than lift their foot, the onset of gait should be the CoM displacement, which starts with the backward CoP shift. If so, the leg muscles driving such a shift are the prime movers. Moreover, since the disequilibrium torque is mechanically equivalent to a forward force acting at the pelvis level, APAs should be required to link the body segments to the pelvis: distributing such concentrated force throughout the body would make all segments move homogeneously. In the aim of testing this hypothesis, we analyzed gait initiation in 15 right-footed healthy subjects, searching for activities in trunk muscles that precede the onset of the backward CoP shift. Subjects stood on a force plate for about 10 s and then started walking at their natural speed. A minimum of 10 trials were collected. A force plate measured the CoP position while wireless probes recorded the electromyographic activities. Recordings ascertained that at gait onset APAs develop in trunk muscles. On the right side, Rectus Abdominis and Obliquus Abdominis were activated in 11 and 13 subjects, respectively, starting on average 33 and 54 ms before the CoP shift; Erector Spinae (ES) at L2 and T3 levels was instead inhibited (9 and 7 subjects, 104 and 120 ms). On the contralateral side, the same muscles showed excitatory APAs (abdominals in 11 and 12 subjects, 27 and 82 ms; ES in 10 and 7 subjects, 75 and 32 ms). The results of this study provide a novel framework for distinguishing postural from voluntary actions, which may be relevant for the diagnosis and rehabilitation of gait disorders.

Symbolic Analysis of the Heart Rate Variability During the Plateau Phase Following Maximal Sprint Exercise.

Cardiac autonomic control is commonly assessed via the analysis of fluctuations of the temporal distance between two consecutive R-waves (RR). Cardiac regulation assessment following high intensity physical exercise is difficult due to RR non-stationarities. The very short epoch following maximal sprint exercise when RR remains close to its lowest value, i.e., the PLATEAU, provides the opportunity to evaluate cardiac regulation from stationary RR sequences. The aim of the study is to evaluate cardiac autonomic control during PLATEAU phase following 60-m maximal sprint and compare the results to those derived from sequences featuring the same length as the PLATEAU and derived from pre-exercise and post-exercise periods. These sequences were referred to as PRE and POST sequences. RR series were recorded in 21 subjects (age: 24.9 ± 5.1 years, 15 men and six women). We applied a symbolic approach due to its ability to deal with very short RR sequences. The symbolic approach classified patterns formed by three RRs according to the sign and number of RR variations. Symbolic markers were compared to more classical time and frequency domain indexes. Comparison was extended to simulated signals to explicitly evaluate the suitability of methods to deal with short variability series. A surrogate test was applied to check the null hypothesis of random fluctuations. Over simulated data symbolic analysis was able to separate dynamics with different spectral profiles provided that the frame length was longer than 10 cardiac beats. Over real data the surrogate test indicated the presence of determinism in PRE, PLATEAU, and POST sequences. We found that the rate of patterns with two variations with unlike sign increased during PLATEAU and in POST sequences and the frequency of patterns with no variations remained unchanged during PLATEAU and decreased in POST compared to PRE sequences. Results indicated a sustained sympathetic control along with an early vagal reactivation during PLATEAU and a shift of the sympathovagal balance toward vagal predominance in POST compared to PRE sequences. Time and frequency domains markers were less powerful because they were dominated by the dramatic decrease of RR variance during PLATEAU.

Dual-Hemisphere Transcranial Direct Current Stimulation on Parietal Operculum Does Not Affect the Programming of Intra-limb Anticipatory Postural Adjustments.

Evidence shows that the postural and focal components within the voluntary motor command are functionally unique. In 2015, we reported that the supplementary motor area (SMA) processes Anticipatory Postural Adjustments (APAs) separately from the command to focal muscles, so we are still searching for a hierarchically higher area able to process both components. Among these, the parietal operculum (PO) seemed to be a good candidate, as it is a hub integrating both sensory and motor streams. However, in 2019, we reported that transcranial Direct Current Stimulation (tDCS), applied with an active electrode on the PO contralateral to the moving segment vs. a larger reference electrode on the opposite forehead, did not affect intra-limb APAs associated to brisk flexions of the index-finger. Nevertheless, literature reports that two active electrodes of opposite polarities, one on each PO (dual-hemisphere, dh-tDCS), elicit stronger effects than the "active vs. reference" arrangement. Thus, in the present study, the same intra-limb APAs were recorded before, during and after dh-tDCS on PO. Twenty right-handed subjects were tested, 10 for each polarity: anode on the left vs. cathode on the right, and vice versa. Again, dh-tDCS was ineffective on APA amplitude and timing, as well as on prime mover recruitment and index-finger kinematics. These results confirm the conclusion that PO does not take part in intra-limb APA control. Therefore, our search for an area in which the motor command to prime mover and postural muscles are still processed together will have to address other structures.

Executive Functions During Submaximal Exercises in Male Athletes: Role of Blood Lactate.

The present study was carried out among 20 healthy young male athletes to determine whether aerobic exercise performed at two different intensities is able to affect executive functions. For this purpose, we used the Stroop Color Word Test (SCWT) to evaluate the ability to inhibit cognitive interference and the Trail Making Test (TMT) to assess organized visual search, set shifting, and cognitive flexibility. Simple Reaction Time (RT), as a measure of perception and response execution, was also evaluated. The experimental protocol included the measure of blood lactate levels with the aim of assessing possible relations between lactate blood values and selected executive functions after a 30-min steady-state test performed at 60% and at 80% of VO2max. The results showed that a 30-min aerobic exercise is not associated with a worsening of executive functions as long as the blood lactate levels stay within the 4 mmol/l threshold.

Postural Control and Stress Exposure in Young Men: Changes in Cortisol Awakening Response and Blood Lactate.

BACKGROUND: It has recently been noticed that the quantity of stress affects postural stability in young women. The study was conducted with the goal of investigating whether increased stress may damagingly effect posture control in 90 young men (71 right-handed and 19 left-handed) while maintaining an upright bipedal posture, while keeping their eyes open or closed. Perceived Stress Scale (PSS) was administered and changes in free cortisol levels were monitored (Cortisol Awakening Response, CAR) in order to evaluate the amount of stress present during awakening, while the Profile of Mood States (POMS) was used to estimate distress on the whole. Posture control was evaluated with the use of a force platform, which, while computing a confidence ellipse area of 95%, was engaged by the Center of Pressure through five stability stations and was sustained for a minimum of 52 s, with and without visual input. Another goal of the experiment was to find out whether or not cortisol increases in CAR were linked with rises of blood lactate levels. RESULTS: CAR, PSS and POMS were found to be extensively related. Furthermore, it has been observed that increases in salivary cortisol in CAR are associated with small but significant increases in blood lactate levels. As expected, stress levels did affect postural stability. CONCLUSIONS: The results of the present study confirm that the level of stress can influence postural stability, and that this influence is principally obvious when visual information is not used in postural control.

Effects of a Bout of Intense Exercise on Some Executive Functions.

The present study examined the effects of an exhaustive exercise on executive functions by using the Stroop Color Word Test (SCWT), Trail Making Test (TMT), A and B, and simple Reaction Time (RT). Thirty adults agreed to participate; 15 participants had a mean age of 24.7 years ± 3.2 Standard Deviation (SD, Standard Deviation) (group YOUNG), while the remaining 15 had a mean age of 58.9 years ± 2.6 SD (group OLD). Each subject performed the cognitive tasks at rest and blood lactate was measured (pre); each subject executed the acute exhaustive exercise and, immediately after the conclusion, executed the cognitive tasks and blood lactate was again measured (end). Cognitive tests were repeated and blood lactate measured 15 min after its conclusion of the exhaustive exercise (post). We observed: (1) a significant positive correlation between blood lactate levels and RT levels; (2) a significant negative relationship between levels of blood lactate and the SCWT mean score; (3) no significant correlation between blood lactate levels and TMT scores (time and errors), both A and B; (4) variations in blood lactate levels, due to exhaustive exercise, and parallel deterioration in the execution of RT and SCWT are significantly more pronounced in the group YOUNG than in the group OLD. The present study supports the possibility that high levels of blood lactate induced by an exhaustive exercise could adversely affect the executive functions pertaining to the prefrontal cortex.

Transcranial Direct Current Stimulation on Parietal Operculum Contralateral to the Moving Limb Does Not Affect the Programming of Intra-Limb Anticipatory Postural Adjustments.

Recent data suggest that the parietal operculum acts as an integration center within a multimodal network, originating from different primary sensory and motor cortices and projecting to frontal, parietal and temporal cortical hubs, which in turn govern cognitive and motor functions. Thus, parietal operculum might also play a crucial role in the integrated control of voluntary movement and posture. As a first step to test this hypothesis, the Anticipatory Postural Adjustments (APAs) stabilizing the arm when the index-finger is briskly flexed were recorded, on the preferred side, in three groups of 10 healthy subjects, before, during and after CATHODAL or ANODAL transcranial Direct Current Stimulation (tDCS, 20 min at 2 mA) applied over the contralateral Parietal Operculum (coPO). Results were compared to those obtained in a SHAM group. In agreement with literature, in the SHAM group the activation of the prime mover Flexor Digitorum Superficialis was preceded by an inhibitory APA in Biceps Brachii and Anterior Deltoid, and almost simultaneous to an excitatory APA in Triceps Brachii. The same pattern was observed in both the CATHODAL and ANODAL groups, with no significant tDCS effects on APAs amplitude and timing. Index-finger kinematics were also unchanged. These negative results suggest that the coPO does not disturb the key network governing APAs in index-finger flexion. Since it has been well documented that such APAs share many features with those observed in trunk and limb muscles when performing several other movements, we suggest that coPO may not be crucial to the general APA control.

Role of lactic acid on cognitive functions.

Objectives: The aim of this research was to establish cognitive changes in relation to blood lactate levels obtained during slow performance of a regimen of exercise sessions. Methods: A total of 15 male professional bodybuilders participated in the study; CrossFit® professionals performed the Workout 15.5, Week 5 Open 2015 consisting of 27-21-15-9 repetitions for time of Row (calories) and Thrusters, with 1-min recovery. Blood lactate, blood glucose, reaction time (RT), execution time of a dual cognitive task, number of errors, and number of omissions were measured at rest, at conclusion of the session, and after recovery for 15 min. Results: The bodybuilders had slightly elevated basal lactate levels than in untrained individuals. The bodybuilders showed significantly increased lactacidemia and decreased RT after completing the training session. Need to define what onset of blood lactate accumulation (OBLA) means. Conclusion: We conclude that bodybuilding fitness regimens lead to an increase in basal lactate levels to 3.16 mmol/L and that acute training sessions can improve attentional performance in relation to lactacidemia, suggesting pro-cognitive effects of a workout.

Heart Rate Kinetics and Sympatho-Vagal Balance Accompanying a Maximal Sprint Test.

When a maximal sprint starts, heart rate (HR) quickly increases. After the exercise ends, HR keeps high for seconds before recovering with a roughly exponential decay. Such decay and its time constant (τoff) have been widely studied, but less attention was devoted to the time delay (tdelay) between sprint end and HR decay onset. Considering the correlation between sympatho-vagal balance and performance, as well as the occurrence of heart failure in cardiopaths during the post-exercise phase, we evaluated sympatho-vagal balance before and after sprint, trying to correlate it with both tdelay and τoff. R-R intervals, recorded in 24 healthy adults from 5 min before to 5 min after a 60-m sprint-test (from Storniolo et al., 2017, with permission of all authors), were re-processed to extract HR variability power (LF and HF) in the low- and high-frequency ranges, respectively. The sympatho-vagal balance, evaluated in pre-test resting period (LF/HF)REST and at steady-state recovery (LF/HF)RECOV, was correlated with tdelay and τoff. Both (LF/HF)REST and (LF/HF)RECOV had a skewed distribution. Significant rank correlation was found for (LF/HF)REST vs. τoff and for (LF/HF)RECOV vs. both τoff and tdelay. The difference (LF/HF)RECOV-REST had a normal distribution and a strong partial correlation with tdelay but not with τoff. Thus, a long tdelay marks a sympathetic activity that keeps high after exercise, while a high sympathetic activity before sprint leads to a slow recovery (high τoff), seemingly accompanying a poor performance.

Disrupt of Intra-Limb APA Pattern in Parkinsonian Patients Performing Index-Finger Flexion.

Voluntary movements induce postural perturbations which are counteracted by anticipatory postural adjustments (APAs). These actions are known to build up long fixation chains toward available support points (inter-limb APAs), so as to grant whole body equilibrium. Moreover, recent studies highlighted that APAs also build-up short fixation chains, within the same limb where a distal segment is moved (intra-limb APAs), aimed at stabilizing the proximal segments. The neural structures generating intra-limb APAs still need investigations; the present study aims to compare focal movement kinematics and intra-limb APA latencies and pattern between healthy subjects and parkinsonian patients, assuming the latter as a model of basal ganglia dysfunction. Intra-limb APAs that stabilize the arm when the index-finger is briskly flexed were recorded in 13 parkinsonian patients and in 10 age-matched healthy subjects. Index-finger movement was smaller in parkinsonian patients vs. healthy subjects (p = 0.01) and more delayed with respect to the onset of the prime mover flexor digitorum superficialis (FDS, p < 0.0001). In agreement with the literature, in all healthy subjects the FDS activation was preceded by an inhibitory intra-limb APA in biceps brachii (BB) and anterior deltoid (AD), and almost simultaneous to an excitatory intra-limb APA in triceps brachii (TB). In parkinsonian patients, no significant differences were found for TB and AD intra-limb APA timings, however only four patients showed an inhibitory intra-limb APA in BB, while other four did not show any BB intra-limb APAs and five actually developed a BB excitation. The frequency of occurrence of normal sign, lacking, and inverted BB APAs was different in healthy vs. parkinsonian participants (p = 0.0016). The observed alterations in index-finger kinematics and intra-limb APA pattern in parkinsonian patients suggest that basal ganglia, in addition to shaping the focal movement, may also contribute to intra-limb APA control.

Ultraconformable Temporary Tattoo Electrodes for Electrophysiology.

Electrically interfacing the skin for monitoring personal health condition is the basis of skin-contact electrophysiology. In the clinical practice the use of stiff and bulky pregelled or dry electrodes, in contrast to the soft body tissues, imposes severe restrictions to user comfort and mobility while limiting clinical applications. Here, in this work dry, unperceivable temporary tattoo electrodes are presented. Customized single or multielectrode arrays are readily fabricated by inkjet printing of conducting polymer onto commercial decal transfer paper, which allows for easy transfer on the user's skin. Conformal adhesion to the skin is provided thanks to their ultralow thickness (<1 µm). Tattoo electrode-skin contact impedance is characterized on short- (1 h) and long-term (48 h) and compared with standard pregelled and dry electrodes. The viability in electrophysiology is validated by surface electromyography and electrocardiography recordings on various locations on limbs and face. A novel concept of tattoo as perforable skin-contact electrode, through which hairs can grow, is demonstrated, thus permitting to envision very long-term recordings on areas with high hair density. The proposed materials and patterning strategy make this technology amenable for large-scale production of low-cost sensing devices.